HomeMy WebLinkAboutSub-Contractor AgreementPLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
BUILDING PERAW
• SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number: 3 C L16 t 5
State of Florida Certification Number (If appiicable):
have agreed to be the
(Company Name/Individual Name)
sub -contractor for Zlwiw ��/�/��- /i0"'os;InI j1d�L
(Type of Trade) (Primary Contractor)
for the project located at N ev-6d Q. D S L
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the
above mentioned project,'I will immediately advise the Building and Zoning Department
of St. Lucie County by personally filing a Change of Contractor notice. (Form: SLCCDV
No. 004-00)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
ORIGINAL SIGNATURES ARE REQUIRED
07--06-1,),
SIGNATURE PRINT NAME DATE
Business Name:
Address:
City/State/Zip:
Phone:
I i4 t3L A, Ty6 -)-&w Sn c.
/ 7 , FL 3`/ff 7
--7 J;L ;� IS 3a-o S email:
OFFICE USE ONLY:
PERMIT # ISSUE DATE
OFFICE USE ONLY:
DATE FILED:
REVISION FEE: '7 2-* 7 -
1. LOCATION/SITE
ADDRESS: / Z
PERMI# '/ ZQ �^ a O
T
---RECEIP-T-#- .
PL4-.1rq1'1da1G-&-DEYELOPMENT_SER 'IL
BM DING& CODE REGULATION DIVISION
2300 v ki.-N A AVENUE JUL Z T, 412
(772)4624553 Public Works
St. Lucie: County, FL
APPLICATION FOR BUILDING. PERMIT REVISIONS
PROJECT INFORMATION
2. DETAILED DESCRIPTION OF PROJECT
REVISIONS:
3. CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #:
- BUSINESS NAME:
QUALICIERS NAME: Ad _1ZJ
ADDRESS:
CITY: �.
PHONE (DAYTIME):
4. OWNER/BUILDER INFORMATION:
ST. LUCIE COUNTY CERT. #:
STATE: %//e �.i cLk� ZIP:
_ FAX:
7 7 2 (p 7 8. 'ZKZ,9
NAME:
ADDRESS:
My: STATE: ZIP:
..PHOlYE: FAX:
S. ARCHITECT/ENGINEER INFORMATION:
NAME: 1..B2k. 51►.-�. ✓ . S (/ C-
ADDRESS: 3(�/
C!f1y: STATE: ZIP:
PHONE (DAYTMEMEE): FAX:
SLCCC: 9/23/09
Revised 04/26/2010
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PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
BUII.DING PERMrr '
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor
State of Florida Certification
PAUL 14
(Company Name/In
/ACC le tC4-Z-
(Type of Trade)
for the project located at
Number: L J 3 a 146 er 5 112,
�sT��7Z -L-/� �-• have agreed to be the
d Name)
sub -contractor for LX441), Az'll�-
(Primary Contractor)
l-\-o bo R,ti,e,-6d !J. P S, Z..
(Project Street Address or Property Tax ID # )
It is understood that, if there is any change of status regarding our participation with the
above mentioned project, III will immediately advise the Building and Zoning Department
of St. Lucie County by personally filing a Change of Contractor notice. (Form: SLCCDV
No. 004-00)
I
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
ORIGINAL, SIGNATURES ARE REQUIRED
SIGNATURE PRINT NAME
�j
�
Business Name: l fj AU`Z A c .
Address: / 5 LJY
City/State/zip: 2riw7 .1 F-L 34f?f 7
Phone: -7-7a- 3a-c S email:
OFFICE USE ONLY:
ISSUE DATE
0-7- 06-/,
DATE
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